Tsuboi R, Unno K, Komatsuzaki H, Ogawa H, Kasai T, Oka K, Takiuchi I, Kitamura K, Higashi N, Nakashima Y, Nishimoto K
Department of Dermatology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.
Nihon Ishinkin Gakkai Zasshi. 1998;39(1):11-6. doi: 10.3314/jjmm.39.11.
Topical treatment with an antifungal agent was performed in 70 cases of onychomycosis (69 cases of tinea unguium and 1 case of Candida onychomycosis). The patients were treated every night by occlusive dressing using bifonazole cream containing 40% urea, and then by simple application of 1% bifonazole solution in the morning. During the treatment period, the softened affected nails were removed as completely as possible with nail clippers and files. The nails were observed every two weeks, and the efficacy was evaluated after 12 weeks. Two cases were excluded and 28 cases dropped out leaving 40 cases for efficacy evaluation. Among the 40 patients, 20 appeared to be mycologically negative (mycological cure rate: 50.0%). Clinical response was judged by the changes in opacity and thickness of the nails. Nine patients were evaluated as showing "marked improvement" and 16 as showing "improvement" (improvement rate: 62.5%). Erosion was noted as an adverse reaction in 2 patients. In one patient, treatment was stopped and the lesion was improved by antibiotic ointment, and in another, treatment was resumed when erosion was cured by discontinuation of the treatment. These results suggest that the topical treatment of onychomycosis by occlusive dressing is a useful method for those patients who have difficulties in or do not wish to be treated with oral antifungal agents.
对70例甲真菌病患者（69例甲癣和1例念珠菌性甲真菌病）进行了抗真菌药物的局部治疗。患者每晚采用含40%尿素的联苯苄唑乳膏封包治疗，然后在早晨单纯涂抹1%联苯苄唑溶液。治疗期间，用指甲刀和锉尽可能彻底地去除软化的患甲。每两周观察一次指甲情况，12周后评估疗效。2例被排除，28例退出，剩余40例进行疗效评估。40例患者中，20例真菌学检查呈阴性（真菌学治愈率：50.0%）。根据指甲透明度和厚度的变化判断临床反应。9例患者评估为“显著改善”，16例为“改善”（改善率：62.5%）。2例患者出现糜烂不良反应。1例患者停止治疗，使用抗生素软膏后病变改善；另1例患者在停止治疗糜烂治愈后恢复治疗。这些结果表明，对于那些难以或不愿接受口服抗真菌药物治疗的患者，封包局部治疗甲真菌病是一种有用的方法。
